Bipolar disorder is a serious mood disorder characterized by drastic changes in moods, activity, and energy levels that interfere with daily life.
The National Institute on Mental Health (NIMH) estimates that 2.6 percent of the American adult population suffers from bipolar disorder.
With bipolar disorder, a person may undergo manic and/or depressive episodes. Mania can cause periods of extremely high energy as well as psychosis, while depression may become so severe that it leads to significant feelings of hopelessness and sadness and possible suicidal ideations. Drugs and alcohol also influence moods and energy levels, and in someone who suffers from bipolar disorder, these side effects may be more pronounced and exaggerated.
Alcohol and drugs can seem like a great way to relieve symptoms of bipolar disorder and may be used to cope with symptoms as a form as self-medication. For instance, marijuana may serve to dampen mood swings temporarily; stimulant drugs like cocaine or methamphetamine can lift depression, and alcohol may blunt mania. In reality, abusing drugs or alcohol only increases possible risk factors, complicates treatment, leads to worsening mental health symptoms, and heightens the odds for drug and alcohol issues, including addiction.
Bipolar Disorder, Drugs, and the Brain
Several regions of the brain and naturally occurring chemicals are involved in mood regulation and subsequent behaviors. Dopamine and serotonin, for example, help to improve moods, increase rates of pleasure, and are involved in impulse-control abilities, memory formation, learning, and motivation. The prefrontal cortex is the part of the brain that helps with information processing, decision-making, and reasoning while the hippocampus and the chemical cortisol are involved in the stress response. High levels of cortisol are generally connected to elevated stress.
Brain imaging has shown that dysfunctions in these parts of the brain and in levels of brain chemicals may be related to disorders such as bipolar disorder. NIMH publishes information on brain imaging that show possible abnormalities in the prefrontal cortex, and other regions and chemicals in the brain related to emotional stimuli and impulsivity, in people diagnosed with bipolar disorder. Major depression and anxiety are often linked to low levels of serotonin and dopamine and high levels of cortisol as well. In addition to being related to brain functioning and structure, bipolar disorder may have genetic connections, NIMH reports.
Drugs and alcohol also interact with brain chemistry and certain regions of the brain. Most enhance pleasure during intoxication by increasing levels of dopamine and/or serotonin. Depressant drugs, like opioids, benzodiazepines, marijuana, and alcohol, increase levels of GABA (gamma-aminobutyric acid) as well. GABA is a kind of brain chemical that works like a natural tranquilizer, helping to dispel stress and anxiety and promote relaxation.
Drugs and alcohol therefore interfere with the normal way the brain sends signals and how it works to regulate emotions, control willpower, and manage decision-making and other cognitive abilities. When drug abuse is continued on a regular basis, changes to the brain and its circuitry become more fixed, and it can become difficult for a person to continue to function normally without drugs. Drug dependence forms, and difficult withdrawal symptoms (which are often the opposite of how the drug makes a person feel) can set in. Individuals may lose control over how much and how often they take drugs, and addiction can be the result.
- Since both drugs and bipolar disorder involve brain circuitry and chemistry, using drugs while battling the mental health disorder can have a greater impact. Changes to the brain may be more pronounced, and drug dependence and addiction may develop sooner. Mood swings, erratic behavior, increased risk-taking, problems controlling impulses and making good decisions, and the ability to regulate emotions may be heightened in someone who abuses drugs and also struggles with bipolar disorder. Depression and anxiety are common side effects of drug withdrawal and bipolar disorder, which can become extreme and potentially lead to increased suicidal ideations or attempts. The “crash” that follows a cocaine binge can be even more extreme in someone with bipolar disorder, for example.
Drugs are mind-altering, which can increase the rate of psychosis in someone suffering from bipolar disorder, especially if someone takes a hallucinogenic drug like LSD or PCP.
Bipolar manic episodes may be more intense and severe, and depressive episodes may be more significant when drugs are involved, Psych Central warns. Addiction and an inability to have any kind of “balance” without drugs may often be the result of doing drugs or drinking alcohol for those with bipolar disorder.
- Complications of Co-Occurring Bipolar Disorder and Addiction
People suffering from bipolar disorder often turn to drugs or alcohol. The journal Current Psychiatry publishes that as many as 60 percent of those diagnosed with bipolar I disorder also suffer from a substance use disorder at some point in their lives. When two disorders, like addiction and bipolar disorder, occur in the same person at the same time, they are termed co-occurring disorders. Difficulties of co-occurring addiction and bipolar disorder include:
- Onset of mood symptoms earlier
- More significant clinical presentations
- Poor outcomes
- More suicide attempts
- Increased rate of anxiety disorders
- Higher number of depressive episodes
- More frequent hospitalizations and rates of accidents
- Increased rapid cycling
- Lower rates of treatment compliance
Both addiction and bipolar disorder can interfere with a person’s ability to perform day-to-day tasks and function normally in society. Homelessness, financial strife, unemployment, interpersonal relationship difficulties, accidents and injuries, troubles with the law and legal entanglements, and physical decline are all possible side effects of both bipolar disorder and addiction.
Doing drugs before the brain is fully developed in early adulthood can also have lasting consequences, leading to an increased rate of mental illness and addiction later in life, the National Institute on Drug Abuse (NIDA) warns. Drug abuse can also potentially cause psychotic side effects and may contribute to the onset of a mental health disorder and bipolar-related symptoms. Drugs can have long-term negative effects on the brain, body, and behaviors, the consequences of which are exacerbated by the simultaneous presence of bipolar disorder.
- Co-Occurring Disorder Treatment Complications
Of the more than 20 million American adults who battled addiction in 2014, the National Survey on Drug Use and Health (NSDUH) reports that nearly 40 percent (almost 8 million people) also suffered from a co-occurring mental health disorder. Co-occurring bipolar disorder and addiction require specialized treatment methods to improve treatment outcomes and recovery rates.
Drug and alcohol withdrawal may be more significant in someone who suffers from bipolar disorder. As such, it should be managed in a medical detox facility to ensure the safety of everyone involved. During medical detox, vital signs and mental health can be continually monitored. Medications are helpful in stabilizing moods as well as the autonomic functions of the central nervous system that can be impacted by drug withdrawal.
Relapse rates for addiction are high, between 40 and 60 percent, NIDA publishes, and may be even higher for someone struggling with co-occurring disorders. Manic and depressive episodes that require hospitalization may be more common as well. A combination of behavioral therapies, medications, coping tools, support groups, and educational programs, along with complementary and adjunct therapies can be very helpful in treating co-occurring disorders.
Because of the complexity of both disorders, it is generally recommended that bipolar disorder and co-occurring addiction be treated simultaneously in an integrated fashion by highly trained professionals. In this manner, treatment providers can work together to carry out a research-based care plan with optimal results.